197
LETTERS TO THE EDITOR
This technique is a simple, safe, and dependable means of producing underwater seal drainage for patients of any age with spontaneous pneumothorax. Al1 the equipment needed is readily available in the operating room. Therefore, a workable underwater seal apparatus can be functioning within minutes in the event of a life-threatening pneumothorax. John G. Broek-Utne, FFASA Jay B. Brodsky, MD Gordon Haddow, MB
Department
of Anesthesia
James B.D. Mark, MD
Department of Surgery Stanford University Medical Center Stanford, CA REFERENCE 1. Holmes
SL, Mark JBD: A simple apparatus
for underwater
Vancomycin
seal in pneumothorax
and the Red-Man
of the newborn.
J Pediatr
Surg 3:87-88, 1968
Syndrome
To the Editor:
In a recent case report, “Cardiovascular Collapse and Refractory Bronchospasm Following Administration of Vancomycin, Esmolol, and Heparin,” Bloom et al state in the Discussion that “Vancomycin is an aminoglycoside antibiotic; thus, it shares the potential toxicity that this group possesses as a whole.“’ In fact, vancomycin is not an aminoglycoside antibiotic, but is a glycopolypeptide that is unrelated to al1 other antibiotics.*.3 Moreover, the quoted side effects of “fever, nausea, pain on injection with or without phlebitis . . .” are relatively rare adverse effects of the aminoglycoside antibiotics.4 Nephrotoxicity, although a complication encountered with both classes of antibiotics, is now infrequent with the newer, more pure preparations of vancomycin.3.5 Finally, one wonders whether the rarity with which the “red-man syndrome” has been reported in the cardiac anesthesia literature is related to the not uncommon practice of giving both H,- and H,-blockers prior to the induction of anesthesia and the administration of vancomycin. As correctly noted by the authors, pretreatment with histamine antagonists may prevent the occurrence of this syndrome. Christopher O’Connor, MD
Department of Anesthesia Massachusetts Genera1 Hospita1 Boston. MA REFERENCES 1. Bloom B, Chalmers PC, Danker PR, et al: Cardiovascular collapse and refractory bronchospasm following administration of vancomycin, esmolol, and heparin. J Cardiothorac Anesth 3:748749,1989 2. Lietman PS: Aminoglycosides and spectinomycin: Aminocyclitols, in Mandell G, Douglas R, Bennett J (eds): Principles and Practice of Infectieus Diseases (ed 2). New York, NY, Wiley, 1985, pp 192-206 3. Fekety R: Vancomycin, in Mandell G, Douglas R, Bennett J
(eds): Principles and Practice of Infectieus York, NY, Wiley, 1985, pp 232-235
Diseases
(ed 2). New
4. Sande M, Mandell G: Antimicrobial agents: The aminoglycosides, in Goodman L, Gilman A, Rall T, Murad F (eds): The Pharmacological Basis of Therapeutics (ed 7). New York, NY, MacMillian, 1985, pp 1160-1170 5. Hermans PE, Wilhelm 62:901-905, 1987
MP: Vancomycin.
Mayo Clin Proc
LETTERS TO THE EDITOR
This technique is a simple, safe, and dependable means of producing underwater seal drainage for patients of any age with spontaneous pneumothorax. Al1 the equipment needed is readily available in the operating room. Therefore, a workable underwater seal apparatus can be functioning within minutes in the event of a life-threatening pneumothorax. John G. Broek-Utne, FFASA Jay B. Brodsky, MD Gordon Haddow, MB
Department
of Anesthesia
James B.D. Mark, MD
Department of Surgery Stanford University Medical Center Stanford, CA REFERENCE 1. Holmes
SL, Mark JBD: A simple apparatus
for underwater
Vancomycin
seal in pneumothorax
and the Red-Man
of the newborn.
J Pediatr
Surg 3:87-88, 1968
Syndrome
To the Editor:
In a recent case report, “Cardiovascular Collapse and Refractory Bronchospasm Following Administration of Vancomycin, Esmolol, and Heparin,” Bloom et al state in the Discussion that “Vancomycin is an aminoglycoside antibiotic; thus, it shares the potential toxicity that this group possesses as a whole.“’ In fact, vancomycin is not an aminoglycoside antibiotic, but is a glycopolypeptide that is unrelated to al1 other antibiotics.*.3 Moreover, the quoted side effects of “fever, nausea, pain on injection with or without phlebitis . . .” are relatively rare adverse effects of the aminoglycoside antibiotics.4 Nephrotoxicity, although a complication encountered with both classes of antibiotics, is now infrequent with the newer, more pure preparations of vancomycin.3.5 Finally, one wonders whether the rarity with which the “red-man syndrome” has been reported in the cardiac anesthesia literature is related to the not uncommon practice of giving both H,- and H,-blockers prior to the induction of anesthesia and the administration of vancomycin. As correctly noted by the authors, pretreatment with histamine antagonists may prevent the occurrence of this syndrome. Christopher O’Connor, MD
Department of Anesthesia Massachusetts Genera1 Hospita1 Boston. MA REFERENCES 1. Bloom B, Chalmers PC, Danker PR, et al: Cardiovascular collapse and refractory bronchospasm following administration of vancomycin, esmolol, and heparin. J Cardiothorac Anesth 3:748749,1989 2. Lietman PS: Aminoglycosides and spectinomycin: Aminocyclitols, in Mandell G, Douglas R, Bennett J (eds): Principles and Practice of Infectieus Diseases (ed 2). New York, NY, Wiley, 1985, pp 192-206 3. Fekety R: Vancomycin, in Mandell G, Douglas R, Bennett J
(eds): Principles and Practice of Infectieus York, NY, Wiley, 1985, pp 232-235
Diseases
(ed 2). New
4. Sande M, Mandell G: Antimicrobial agents: The aminoglycosides, in Goodman L, Gilman A, Rall T, Murad F (eds): The Pharmacological Basis of Therapeutics (ed 7). New York, NY, MacMillian, 1985, pp 1160-1170 5. Hermans PE, Wilhelm 62:901-905, 1987
MP: Vancomycin.
Mayo Clin Proc
